Time / Date: 1/17/2024 12:43:07
JSP ID: 2093
Scope of Work: Re-energize breaker for FACP (system 3), verify voltage on FACP power supply, verify voltage for battery charging current.
Work Order: Training
Building: 75A
Person in Charge: Travis Ray
Lead / Supervisor: Other
Logged Email: tlray@lbl.gov
Division: Facilities
QEW Level: QEW 1
Modes of Work: Mode 1 - LOTO & Zero Voltage Verification, Mode 2 - Energized Diagnostics, Testing and Troubleshooting, Visual Inspection
Second Person Requirement: Not Required
Second Person Identified: NA
List Other Participants: NA
Affected Persons Notified: N/A
Switching: Non-Hazardous Switching
Panel / Equipment ID: FACP system 3, breaker234a
System Information Review: Arc Flash Labels,
Control of Hazardous Energy: LOTO Not Required (Mode 2 or 3 only)
Equipment Condition: Properly installed, No signs of impending failure

Sequence of Job Steps

List basic sequence of steps from start to finish.

Identify breaker for FACP, switch Breaker, verify voltage.

Control of Work Area

Minimum Approach Boundary: 42”
Barricade Tape / Attendant: Danger - Red

Shock Risk Assessment

System Voltage: 120 Vac
Limited Approach Boundary: 42 inches
Restricted Approach Boundary: 3 inches
Will the hands enter the RAB: Yes
Voltage Glove Class: 0
Will any other part of the body enter the RAB: No

Arc Flash Risk Assessment

Incident Energy: 1.2 cal/cm 2 cal/cm2
Arc Flash Boundary: None
Working Distance: No Arc Flash Hazard Present
Arc Flash PPE Level: Minimum PPE for Electrical Work
Incident Energy Reduction Measures: 0

Capacitor Hazards

Capacitor Bus Voltage: None
Capacitor total stored energy (joules): None
Discharge wait time (minutes): NA

Emergency Response Plan

Nearest Landline Location: 75
Emergency Number to Call: 911
Sufficient cell phone signal? Yes
Clear exit path? Yes
AED Location: Ext to FACP
Fire Extinguisher Location: Outside back exit at 85a
Contact release method available and tested: Voltage gloves

Environmental Conditions

Does the environment present additional hazards that should be addressed?

None

Error Precursors

Task Demands: Time pressure (in a hurry)
Work Environment:
Individual Capabilities:
Human Nature:
Error Precursor Mitigations:

Follow iSM

PPE Inspections

Safety glasses (ANSI Z87),
Rubber insulating gloves and leather protectors,
Non-melting footwear that fully covers the feet,
Removal of conductive articles,
Multimeter and other electrical test instruments

Notes / Other

Perform Job Breifing

PIC Conducts the Job Briefing. Cover all the contents of the Job Safety Plan.

A Job Briefing at a minimum must include:
  1. Detailed Scope of Work
  2. Shock and arc flash hazards for each task
  3. Controls to mitigate the hazards (procedures, precautions, energy source controls, PPE requirements)
  4. Work area controls (barricades, signs, attendants)
  5. Emergency Response Plan

Rev 2023.08.22.1
Form Content and Feedback Contact: Michael Rose -- mvr@lbl.gov